Wellness Evaluation | BioEnergetic Therapeutics

BioEnergetic Therapeutics

Personal Wellness Evaluation

Your evaluation starts the teamwork for building the best tailored session for you!
Immediately benefit a greater life balance when you submit your thoughtful pre-assessment of stress as your brain sorts it out and reorganizes information.
There are no wrong answers! Write about what prompted you to schedule your upcoming appointment. Think about what feels out of sync in your life and why.
An advanced submission of 2 days prior to your consultation or at your earliest time is appreciated.
For best results, please login to avoid losing your information.

Client's Full Name

Email Address

Mobile

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

Date of Birth

Parents' Name (If Client Is Child)

New Clients: Who referred you?

Given the reason(s) that you booked an upcoming BioEnergetic Therapeutics Session, what do you aspire to heal?

At this point, what can you thoughtfully imagine healing could look and feel like? In other words, how would you recognize that you are healing, improving or growing?

Building on your last Q&A, I would like for you to take the time to envision how healing would also connect to other areas of your life. How would healing harmonize your relationships, work, service to others, and personal pursuits?

What areas are there in your life that you feel struggle or disconnection within yourself, relationships and life that feel disruptive to the flow in your life?

What kind of things, words or activities feel supportive, rejuvenating and strengthening, which can help regulate you in the face of stressful circumstances?

What are your current wellness habits with nutrition, exercise or supplementation? Do you feel these protocols are working for you?

Are you currently supported by medical interventions such as medications or other therapies? If yes, please list that here.

Do you have any vibrational tools available for use like essential oils, essences, tuning forks, color therapy, etc.?

And, want else is on your mind that you feel important to share or need to put out there…

Please upload a relevant file, such as recent labs here. If more than one, please bundle them into a single PDF prior to uploading.

Upload Document

Please upload any relevant phots of symptoms or documents here.

Upload Pictures

Upload Document

Upload File

Upload Image

Upload Document

Upload Documen

Upload Image

Upload Video

Please subscribe me to occasional mailings and updates

Thanks for submitting!

Shelly Early

BioEnergetic Wellness Consultant
Providing An Alternative Approach To Healing

BioEnergetic Therapeutics

Personal Wellness Evaluation

Shelly Early
BioEnergetic Wellness Consultant
info@shellyearly.com